{"entity":{"id":"efs","kind":"term","name":"Event-free / disease-free survival (EFS, DFS, iDFS, RFS)","aka":["EFS","DFS","iDFS","RFS","event-free survival","recurrence-free survival","recurrence-free","relapse-free survival","relapse-free","invasive disease-free survival","distant disease-free survival","distant recurrence-free","failure-free survival","time to recurrence"],"tldr":"In early-stage cancer: how long patients stay free of recurrence, progression, or death.","summary":"Event-free survival and its relatives, disease-free survival, invasive disease-free survival and recurrence-free survival, are the endpoints used in early-stage cancer to measure how long patients stay free of recurrence, progression or death. Event definitions differ by trial: EFS in KEYNOTE-522 counts progression that precludes surgery, iDFS in monarchE and NATALEE counts invasive recurrence, second cancers and death, and RFS is the measure in INTerpath-001 (V940-001). These endpoints are accepted surrogates for adjuvant approvals. They appear in the NADINA, KEYNOTE-716, KEYNOTE-689, MATTERHORN, ZUMA-7, ASCENT-05 / OptimICE-RD and TROPION-Breast03 trial records, in the Neuroblastoma (paediatric) entry and in the KEYNOTE-522 and CheckMate 816 papers.","asOf":"2026-09-04","wikipedia":"https://en.wikipedia.org/wiki/Disease-free_survival","links":[{"label":"Wikipedia","url":"https://en.wikipedia.org/wiki/Disease-free_survival"},{"label":"Conroy, N Engl J Med 2018: PRODIGE 24, modified FOLFIRINOX or gemcitabine as adjuvant therapy (disease-free survival primary endpoint)","url":"https://doi.org/10.1056/nejmoa1809775"},{"label":"Punt, JNCI 2007: endpoints in adjuvant treatment trials, systematic review and proposed definitions (disease-free survival)","url":"https://doi.org/10.1093/jnci/djm024"}],"tags":[],"related":["surrogate-validation","surrogate-endpoint","pcr","mrd","os","group-sequential-design","absolute-benefit"],"cancers":["pancreatic"],"sections":[],"technologies":[],"targets":[],"drugs":[],"companies":[],"institutions":[],"pathways":[],"terms":["clinical-benefit-response"],"trials":["keynote-522","natalee","interpath-001","monarche","keynote-564","adaura","challenge"],"people":[],"bottlenecks":[],"keyPapers":[],"journals":[],"dependsOn":[],"notes":["Disease-free survival is the primary endpoint of the adjuvant pancreatic cancer trials: in PRODIGE 24 median disease-free survival was 21.6 months with modified FOLFIRINOX against 12.8 months with gemcitabine (hazard ratio 0.58 for a cancer-related event, second cancer or death), and overall survival followed (Conroy 2018). The definition, time from randomisation to any event irrespective of cause, follows the adjuvant-trial consensus (Punt 2007)."],"category":"Endpoints"},"route":"/terms/efs/","neighbours":{"term":[{"id":"absolute-benefit","kind":"term","name":"Absolute versus relative benefit (number needed to treat)","route":"/terms/absolute-benefit/"},{"id":"clinical-benefit-response","kind":"term","name":"Clinical benefit response (the gemcitabine trial endpoint)","route":"/terms/clinical-benefit-response/"},{"id":"endpoint","kind":"term","name":"Endpoint","route":"/terms/endpoint/"},{"id":"group-sequential-design","kind":"term","name":"Group sequential design, stopping rules and alpha spending","route":"/terms/group-sequential-design/"},{"id":"invasive-cancer","kind":"term","name":"Invasive","route":"/terms/invasive-cancer/"},{"id":"mrd","kind":"term","name":"Minimal / molecular residual disease (MRD)","route":"/terms/mrd/"},{"id":"os","kind":"term","name":"Overall survival 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